Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (2) : 251-259     DOI: 10.1007/s11684-015-0393-z
RESEARCH ARTICLE |
Attitude toward preventive counseling and healthy practices among medical students at a Colombian university
Luz Helena Alba1,*(),Nora Badoui1,Fabián Gil2
1. Department of Preventive and Social Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
2. Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
Download: PDF(125 KB)   HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
Abstract  

Unhealthy behaviors of medical students influence their attitudes toward preventive counseling. The burden of chronic diseases is continually growing in developing countries, emphasizing the need for the increased role of general practitioners in preventive counseling. The objective of this study was to describe the effect of medical training on the risk profiles and attitudes of medical students toward preventive counseling in a Colombian university. Students in their first and fifth years of training were surveyed using the “Healthy Doctor= Healthy Patient” questionnaire to assess counseling attitudes; personal practices, such as risky drinking, smoking, inadequate nutrition, and non-compliance with physical activity recommendations; and the university environment. The association among these components was estimated, as well as the effect of the university environment. Risky drinking and smoking decreased from first to fifth year (59.3% vs. 37.1%, P = 0.021 and 31.5% vs. 25.9%, P = 0.51, respectively), whereas inadequate nutrition and non-compliance with physical activity recommendations increased. Physical activity (PA) was associated with positive counseling attitude (ORs: nutrition 7.6; alcohol 5.2; PA 10.6). Areas governed by institutional policies that are emphasized in the curriculum positively affected student practices. PA promoted preventive counseling and healthy lifestyles most effectively. Universities should therefore strengthen their preventive medicine curricula and modify social determinants.

Keywords lifestyle      medical students      preventive medicine      counseling      universities      schools      medical     
Corresponding Authors: Luz Helena Alba   
Just Accepted Date: 26 March 2015   Online First Date: 28 April 2015    Issue Date: 22 May 2015
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-015-0393-z     OR     http://academic.hep.com.cn/fmd/EN/Y2015/V9/I2/251
First year (n = 54) Fifth year (n = 54) P
Age (average)a 18.3 22.2 <0.001
Sex (%)b Male 48.1 42.6 0.63
Female 51.9 57.4
Socio-economic status (%)c Low 0 3.7 0.34
Middle 59.3 53.7
High 40.7 42.6
BMI (Body mass index) (%)d Low 7.4 9.3 0.53
Normal 85.2 79.6
Overweight 5.6 11.1
Obesity 1.8 0
Health status perception (%)e Good 98.2 94.4 0.02
Moderate 1.8 5.6
Bad 0 0
Tab.1  Student characteristics
First year students (%) Fifth year students (%) P
Nutrition
>5 servings of fruits and vegetables 57.4 0 <0.001
3 - 4 servings of fruits and vegetables 16.7 0
0 - 2 servings of fruits and vegetables 25.9 100
Smoking
Non-smoker 68.5 74.1 0.51
Smokes 10 or less cigarettes/day 27.8 25.9
Smokes 11 or more cigarettes/day 3.7 0
Alcohol
Non-risky consumption 40.7 62.9 0.021
Risky consumption 59.3 37.1
Physical activity
Compliance with recommendation 46.3 25.9 0.014
Mildly activea 0 7.4
Sedentaryb 53.7 66.7
Perceived barriers
Physical activity
Lack of time 87 85.2 0.99
Lack of energy 55.6 68.5 0.12
Lack of social support 27.8 38.9 0.31
Fruit and vegetable consumption
Difficult access 13 16.7 0.4
High cost 5.6 16.7 0.06
Dislike of fruits 13 13 0.61
Dislike of vegetables 29.6 22.2 0.25
Tab.2  Prevalence of risk factors and perceived barriers for healthy behavior
Favorable Unfavorable Indifferent
Opinions of fifth year students toward the role of faculty in risk factor prevention [% (95% CI)]
Nutrition 20.4 (11.4 – 33.6) 46.3 (33.2 – 60.0) 33.3 (21.8 – 47.3)
Smoking 57.4 (43.6 – 70.2) 22.2 (12.8 – 35.7) 20.4 (11.4 – 33.6)
Alcohol 22.2 (12.8 – 35.7) 40.7 (28.2 – 54.6) 37.0 (25.0 – 51.0)
Physical activity 14.8 (7.4 – 27.4) 59.3 (45.4 – 71.8) 25.9 (15.7 – 39.6)
Opinions of fifth year students toward preventive medicine curriculum [% (95% CI)]
Nutrition 20.4 (11.4 – 33.6) 59.3 (45.4 – 71.8) 20.4 (11.4 – 33.6)
Smoking 75.9 (62.3 – 85.7) 5.6 (1.7 – 16.4) 18.5 (10.1 – 31.6)
Alcohol 53.7 (40.0 – 66.8) 25.9 (15.7 – 39.6) 20.4 (11.4 – 33.6)
Physical activity 29.6 (18.7 – 43.5) 48.2 (34.9 – 61.7) 22.2 (12.8 – 35.7)
Attitudes of fifth year students toward preventive medicine counseling [% (95% CI)]
Physician as a model for the patients 77.8 (64.3 – 87.2) 9.3 (3.8 – 20.9) 13.0 (6.2 – 25.3)
Importance of prevention counseling 88.9 (76.8 – 95.1) 1.9 (0.2 – 12.7) 9.3 (3.8 – 20.9)
Preference of prevention over treatment 9.3 (3.8 – 20.9) 79.6 (66.4 – 88.6) 11.1 (4.9 – 23.1)
Tab.3  Opinions and attitudes of fifth year students toward prevention
Adjusted OR (95% CI)
Inadequate nutrition Risky alcohol consumption Smoking Non-compliance with physical activity recommendations
Sex
?Female 1 1 1 1
?Male 2.6 (0.6 – 11.5) 5.0 (1.9 – 13.0) 3.9 (1.2 – 12.2) 1.0 (0.4 – 2.5)
Age (year) 1.7 (1.1 – 2.5) 1.5 (0.9 – 2.3) 2.2 (1.2 – 3.8) 0.9 (0.6 – 1.4)
Socioeconomic status
?High 1 1 1 1
?Low/medium 0.4 (0.1 – 1.5) 0.5 (0.2 – 1.3) 2.7 (0.8 – 8.7) 1.7 (0.7 – 4.1)
Body mass index (kg/m2)
?Normal 1 1 1 1
?Low weight 1.2 (0.1 – 13.5) 1.8 (0.3 – 12.0) 1.0 (0.1 – 8.9) 1.4 (0.2 – 7.9)
?Overweight/obesity 0.5 (0.3 – 5.9) 1.4 (0.3 – 8.0) 11.9 (1.5 – 96.1) 0.2 (0.0 – 0.8)
University environment (opinion)
?Favorable 1 1 1 1
?Indifferent/unfavorable 1.7 (0.3 – 9.1) 0.7 (0.2 – 2.0) 0.2 (0.5 – 0.8) 0.9 (0.3 – 2.6)
Curriculum (opinion)
?Favorable 1 1 1 1
?Indifferent/unfavorable 1.3 (0.4 – 4.6) 0.9 (0.4 – 1.8) 1.8 (0.7 – 4.6) 1.2 (0.6 – 2.4)
Medical knowledge
?Adequate* 1 1 1 1
?Inadequate NC 1.1 (0.3 – 3.9) 0.1 (0.2 – 0.5) 1.9 (0.5 – 6.4)
Physician as a model (opinion)
?Favorable 1 1 1 1
?Indifferent/unfavorable 0.9 (0.4 – 2.4) 2.2 (1.2 – 4.2) 2.6 (1.2 – 5.6) 0.9 (0.5 1.6)
Year of training
?First year 1 1 1 1
?Fifth year NC 0.3 (0.1 – 0.8) 0.1 (0.0 – 0.4) 2.4 (0.9 – 6.5)
Tab.4  Factors associated with risk prevalence in first and fifth year medical students
1 World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization, 2008
2 Jordan CO, Slater M, Kottke TE. Preventing chronic disease risk factors: rationale and feasibility. Medicina (Kaunas)2008; 44(10): 745–750
pmid: 19001832
3 Horton ES. Effects of lifestyle changes to reduce risks of diabetes and associated cardiovascular risks: results from large scale efficacy trials. Obesity (Silver Spring)2009; 17(Suppl 3): S43–S48
doi: 10.1038/oby.2009.388 pmid: 19927146
4 Ministerio de Protección S, de Antioquia U. Facultad Nacional de Salud Pública. Análisis de la situación de salud en Colombia 2002-2007. Morbilidad y mortalidad de la población colombiana. Bogotá D.C.: Imprenta Nacional de Colombia, 2010
5 Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012; 344: e1389
doi: 10.1136/bmj.e1389 pmid: 22451477
6 Lancaster T, Stead LF. Individual behavioural counseling for smoking cessation. Cochrane Database Syst Rev 2005; 2: CD001292
7 Murillo R. Enfermedades crónicas. En: Salud Pública-Perspectivas. Malagón G, Moncayo A (Eds.). 2a edición. Bogotá D.C.: Editorial Panamericana, 2011
8 Jepson RG, Harris FM, Platt S, Tannahill C. The effectiveness of interventions to change six health behaviours: a review of reviews. BMC Public Health 2010; 10: 538
doi: 10.1186/1471-2458-10-538 pmid: 20825660
9 Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol 2011; 67(2): 143–154
doi: 10.1002/jclp.20758 pmid: 21157930
10 Ministerio de la Protección Social, Coldeportes. Hábitos y estilos de vida saludables. Bogotá D.C.: Ministerio de la Protección Social, Coldeportes, 2011
11 Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey SG. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev. 2011; 1: CD 001561
12 Thompson DR, Chair SY, Chan SW, Astin F, Davidson PM, Ski CF. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs 2011; 20(9-10): 1236–1244
doi: 10.1111/j.1365-2702.2010.03558.x pmid: 21492271
13 Demak MM, Becker MH. The doctor-patient relationship and counseling for preventive care. Patient Educ Couns 1987; 9(1): 5–24
doi: 10.1016/0738-3991(87)90105-4 pmid: 10301559
14 Borrelli B, Lee C, Novak S. Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses. Prev Med 2008; 46(4): 358–363
doi: 10.1016/j.ypmed.2007.09.001 pmid: 17950452
15 Wilson DM, Ciliska D, Singer J, Williams K, Alleyne J, Lindsay E. Family Physicians and Exercise Counseling: Can they be influenced to provide more? Can Fam Physician 1992; 38: 2003–2010
pmid: 21221270
16 Frank E, Segura C. Health practices of Canadian physicians. Can Fam Physician 2009; 55: 810–811.e7
17 Shahar DR, Henkin Y, Rozen GS, Adler D, Levy O, Safra C, Itzhak B, Golan R, Shai I. A controlled intervention study of changing health-providers’ attitudes toward personal lifestyle habits and health-promotion skills. Nutrition 2009; 25(5): 532–539
doi: 10.1016/j.nut.2008.11.020 pmid: 19230614
18 Frank E, Segura C, Shen H, Oberg E. Predictors of Canadian physicians’ prevention counseling practices. Can J Public Health 2010; 101(5): 390–395
pmid: 21214054
19 Rogers LQ, Gutin B, Humphries MC, Lemmon CR, Waller JL, Baranowski T, Saunders R. Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived success. Teach Learn Med 2006; 18(3): 215–221
doi: 10.1207/s15328015tlm1803_5 pmid: 16776608
20 Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J Sport Med 2000; 10(1): 40–48
doi: 10.1097/00042752-200001000-00008 pmid: 10695849
21 Howe M, Leidel A, Krishnan SM, Weber A, Rubenfire M, Jackson EA. Patient-related diet and exercise counseling: do providers’ own lifestyle habits matter? Prev Cardiol 2010; 13(4): 180–185
doi: 10.1111/j.1751-7141.2010.00079.x pmid: 20860642
22 Frank E, Elon L, Hertzberg V. A Quantitative assessment of a 4-year intervention that improved patient counseling through improving medical student health. MedGenMed 2007; 9(2): 58
pmid: 17955112
23 Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study. BMJ 2008; 337(nov07 1): a2155
doi: 10.1136/bmj.a2155 pmid: 18996938
24 Duperly J, Lobelo F, Segura C, Sarmiento F, Herrera D, Sarmiento OL, Frank E. The association between Colombian medical students’ healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses. BMC Public Health 2009; 9(1): 218
doi: 10.1186/1471-2458-9-218 pmid: 19575806
25 Barss P, Grivna M, Al-Maskari F, Kershaw G. Strengthening public health medicine training for medical students: development and evaluation of a lifestyle curriculum. Med Teach 2008; 30(9-10): e196–e218
doi: 10.1080/01421590802334267 pmid: 19117217
26 Spencer EH, Frank E, Elon LK, Hertzberg VS, Serdula MK, Galuska DA. Predictors of nutrition counseling behaviors and attitudes in US medical students. Am J Clin Nutr 2006; 84(3): 655–662
pmid: 16960182
27 Pontificia Universidad Javeriana. Facultad de Medicina. Currículo vigente carrera de medicina 2004-2013. Bogotá D.C., 2013. Available at: http://puj-portal.javeriana.edu.co/portal/pls/portal/!PORTAL.wwpob_page.show?_docname=4762088.PDF
28 Granados MC, Alba LH, Becerra NA. La Pontificia Universidad Javeriana como un escenario para la promoción de la salud. Universitas Médica. 2009; 50: 184–193
29 StataCorp. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP, 2009
30 Ministerio de Salud. II Estudio nacional de factores de riesgo de enfermedades crónicas- ENFREC II. Bogotá D.C: Ministerio de Salud, 1999
31 Ministerio de la Protección Social. Colciencias, CENDEX, S.E.I.S.A. Encuesta Nacional de Salud 2007. 1a Edición. Bogotá D.C.: Ministerio de la Protección Social, 2009
32 República de Colombia. Ley 1335 de 2009. Diario oficial No. 47.417 de 21 de julio de, 2009
33 Rodríguez E. Consumo de sustancias psicoactivas en Colombia-1996. Bogotá D.C.: Editorial carrera 7a, 1997
34 de Colombia R. Dirección Nacional de Estupefacientes, Ministerio de la Protección Social. Estudio nacional sobre consumo de sustancias psicoactivas en Colombia- 2008. Bogotá D.C.: Editora Guadalupe, 2009
35 Yancey AK, Sallis RE, Bastani R. Changing physical activity participation for the medical profession. JAMA 2013; 309(2): 141–142
doi: 10.1001/jama.2012.127989 pmid: 23299602
36 ángyán L. Promoting physical activity in medical education. Acta Physiol Hung 2004; 91(2): 157–166
doi: 10.1556/APhysiol.91.2004.2.7 pmid: 15484715
37 Instituto Colombiano de Bienestar Familiar (ICBF), Instituto Nacional de Salud (INS), Ministerio de la Protección Social (MPS), Asociación Pro-bienestar de la Familia Colombiana (PROFAMILIA). Encuesta Nacional de Situación Nutricional en Colombia 2010-ENSIN. 1a Edición. Bogotá D.C.: Instituto Colombiano de Bienestar Familiar, 2011
38 Rosselli D, Rey O, Calderón C, Rodríguez MN. Smoking in Colombian medical schools: the hidden curriculum. Prev Med 2001; 33(3): 170–174
doi: 10.1006/pmed.2001.0864 pmid: 11522157
39 Frank E, Carrera JS, Elon L, Hertzberg VS. Predictors of US medical students’ prevention counseling practices. Prev Med 2007; 44(1): 76–81
doi: 10.1016/j.ypmed.2006.07.018 pmid: 16978687
40 Unger JP, Van Dormael M, Criel B, Van der Vennet J, De Munck P. A plea for an initiative to strengthen family medicine in public health care services of developing countries. Int J Health Serv 2002; 32(4): 799–815
doi: 10.2190/FN20-AGDQ-GYCP-P8R6 pmid: 12456126
41 Global Youth Tobacco Survey Collaborating Group. Differences in worldwide tobacco use by gender: findings from the Global Youth Tobacco Survey. J Sch Health 2003; 73(6): 207–215
doi: 10.1111/j.1746-1561.2003.tb06562.x pmid: 12899101
[1] Shirin Anil,Mohamed Shukry Zawahir,Redhwan Ahmed Al-Naggar. Effectiveness of preventive medicine education and its determinants among medical students in Malaysia[J]. Front. Med., 2016, 10(1): 91-100.
[2] Guozheng Li,Xuewen Zuo,Baoyan Liu. Scientific computation of big data in real-world clinical research[J]. Front. Med., 2014, 8(3): 310-315.
[3] Zhuyuan Fang,Xiaowei Fan,Gong Chen. A study on specialist or special disease clinics based on big data[J]. Front. Med., 2014, 8(3): 376-381.
[4] Yixin Zhong,Baoyan Liu,Hua Qu,Qi Xie. Methodological challenges to human medical study[J]. Front. Med., 2014, 8(3): 328-336.
[5] Hai-Qiang Wang, Zhi-Heng Liu, Yong-Zhao Zhang, Zhuo-Jing Luo. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges[J]. Front Med, 2012, 6(1): 79-84.
[6] Douglas Sipp. The unregulated commercialization of stem cell treatments: a global perspective[J]. Front Med, 2011, 5(4): 348-355.
[7] Ze-Guang HAN MD, . Systems biomedical analysis of Schistosoma japonicum[J]. Front. Med., 2010, 4(2): 157-165.
[8] REN Peitu, LU Baochun, RUAN Xinxian, CHEN Zhiliang, MA Yuliang, FU Hong. Therapeutic effect of medical glue combined with the great omentum in severe tunica muscularis injury[J]. Front. Med., 2008, 2(2): 143-146.
[9] ZHANG Kaigang, ZENG Bingfang, ZHANG Changqing. Visualization of vascular ultrastructure during osteogenesis by tissue engineering technique[J]. Front. Med., 2007, 1(2): 181-184.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed